Linh Tran Pham,1 Si Dung Chu,2 Minh Thi Tran31Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam; 2Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam; 3Department of Internal Medicine, Vietnam University of Traditional Medicine, Hanoi, VietnamCorrespondence: Si Dung Chu, Health Management Training Institute, Hanoi University of Public Health (HUPH), Hanoi, Vietnam, Tel + 84 906 086168, Email cds@huph.edu.vn; sichu.bvbachmai@gmail.comObjective: To evaluate rehospitalization rates and identify modifiable risk factors in chronic heart failure (CHF) patients enrolled in an optimal management and treatment program.Methods: A prospective cross-sectional study with longitudinal follow-up was conducted on 163 patients diagnosed with CHF patients (Framingham criteria) at an international hospital model in Vietnam from January 2022 to November 2023. Clinical, behavioral, and comorbid factors were analyzed over 6 months.Results: The program demonstrated high efficacy with a low 6-month rehospitalization rate of 9.82%. Statistical analysis revealed significant correlations between rehospitalization and male gender (p< 0.01), alcohol consumption (p< 0.05), smoking (p< 0.05), elevated heart rate (p< 0.001), and NYHA functional class (p< 0.05). Key comorbidities including coronary heart disease (p< 0.01), sinus tachycardia (p < 0.001), atrial fibrillation (p< 0.01), and sleep disorders were also significantly associated with readmission (p< 0.05).Conclusion: Optimizing CHF outcomes requires a comprehensive intervention strategy targeting both modifiable lifestyle factors and underlying clinical comorbidities like sleep disorders.Keywords: risk profile, lifestyle intervention, underlying disease, rehospitalization rate, chronic heart failure
Wenhui Huang,1,2 Fang Liu,1,2 Yangfan Hu,1,2 Guoyan Xu,1– 4 Liangdi Xie,1– 5 Tingjun Wang1– 41Department of General Practice, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 2Department of General Practice, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 3Fujian Hypertension Research Institute, Fuzhou, Fujian, People’s Republic of China; 4General Practitioner Branch of Fujian Medical Doctor Association, Fuzhou, Fujian, People’s Republic of China; 5Branch of National Clinical Research Center for Aging and Medicine, Fujian Province; Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Tingjun Wang, Department of General Practice, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Huashan Road 999, Changle District, Fuzhou, 350212, People’s Republic of China, Email 1870311076@qq.comBackground: The aim of this study was to investigate the association between endothelial activation and stress index (EASIX), a composite marker of endothelial dysfunction, and microalbuminuria.Methods: This cross-sectional study included adult patients from Departments of General Practice and Geriatrics at the First Affiliated Hospital of Fujian Medical University between January 2017 and December 2023. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) of 30– 300 mg/g. EASIX was calculated as lactate dehydrogenase (U/L) × serum creatinine (mg/dL) / platelet count (109/L). The association of EASIX with microalbuminuria was evaluated using logistic regression models, restricted cubic splines (RCS), and subgroup analyses.Results: Among 3,126 patients, 403 (12.9%) had microalbuminuria and exhibited significantly higher EASIX levels compared with those with normal UACR [median (P 25~P 75): 0.63 (0.47– 0.90) vs 0.62 (0.48– 0.82) mg/g, P = 0.019]. Multivariate linear regression identified EASIX as an independent factor for lnUACR (β = 0.100, 95% CI: 0.115~0.233, P< 0.001). Logistic regression further showed that EASIX was independently associated with microalbuminuria (OR = 1.420, 95% CI:1.167~1.728, P < 0.001). In the fully adjusted model, EASIX quartiles remained independently associated with microalbuminuria (OR = 1.395, 95% CI: 1.147~1.698, P < 0.001). RCS analysis revealed a U-shaped non-linear association (P for non-linear = 0.007), with an inflection point at EASIX = 0.625, above which the risk of microalbuminuria increased significantly. This association remained consistent across subgroups stratified by age, sex, body mass index (BMI), and hypertension or diabetes status in patients with EASIX > 0.625, with no significant interactions.Conclusion: This study provides evidence that EASIX, a composite marker derived from routine blood tests, is independently associated with microalbuminuria. A threshold of 0.625 for the EASIX may warrant further investigation in longitudinal studies.Keywords: endothelial activation and stress index, microalbuminuria, endothelial dysfunction, hypertension, diabetes
Abbas-Ali Vafaei,1 Raheb Ghorbani,2,3 Parnian Zarvani,4 Monir Nobahar5,61Research Center of Physiology, Neuroscience Research Institute, Semnan University of Medical Sciences, Semnan, Iran; 2Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; 3Department of Epidemiology and Biostatistics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran; 4Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran; 5Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; 6Department of Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, IranCorrespondence: Monir Nobahar, Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran, Tel +982333654190, Fax +982333654209, Email Monir.nobahar@gmail.com; nobahar43@semums.ac.ir; nobahar43@yahoo.comPurpose: A blood pressure of 140/90 and above indicates high blood pressure. High blood pressure, a silent killer, is a major public health problem. Research has shown that treatment adherence plays an important role in controlling hypertension. Therefore, this study aimed to determine the level of treatment adherence among patients with high blood pressure in the health center of Semnan, 2024.Methods: In this cross-sectional study, 400 patients with high blood pressure in the health center of Semnan were selected using a multistage sampling method and enrolled after meeting the inclusion and exclusion criteria. After obtaining informed consent, demographic information and treatment adherence questionnaires were completed.Results: Of the patients, 54.3% were female. The mean ± standard deviation of age was 48.2 ± 18.2 years, with a median of 49 years. The mean ± standard deviation of the treatment adherence score was 83.8 ± 12.4 (out of 115), with a median of 89.6. Overall, 77.5% (95%CI: 73.4%-81.6%) of the patients were adherent to treatment (score ≥ 86). Treatment adherence was not significantly associated with age, gender, body mass index, marital status, educational level, employment status, number of children, income level, medical history, blood pressure, medication-related variables, duration of hypertension, duration of antihypertensive treatment, or other comorbidities (p > 0.05).Conclusion: Most patients had high treatment adherence, and no demographic characteristics were significantly associated with treatment adherence. Evidence indicates that knowledge influences patients’ health behaviors. Therefore, policymakers and healthcare planners should prioritize educating patients with hypertension about the importance of lifestyle modification for the prevention, management, and control of hypertension. The study has several limitations, including reliance on self-reported data, its cross-sectional design, and limited generalizability of the findings.Keywords: blood pressure, demographic, disease management, health behavior, hypertension, medication adherence, patients, treatment adherence
Seyedeh-Tarlan Mirzohreh,1 Samad Ghaffari,1 Elnaz Javanshir,1 Mahshid Dehghan,1 Faezeh Tarighat,1 Noushin Mohammadifard,2 Nizal Sarrafzadegan,2 Neda Roshanravan,1 Ehsan Zarepur21Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IranCorrespondence: Neda Roshanravan, Cardiovascular Research Center, Tabriz University of Medical Sciences, Shahid-Madani Hospital, Tabriz, Iran, Tel +984133357767, Fax +9851666-15573, Email neda.roshanravan10@email.com Ehsan Zarepur, Cardiovascular Research Center, Isfahan University of Medical Sciences, Shahid-Chamran Heart Center, Isfahan, Iran, Email ehsanzarepur@gmail.comPurpose: Premature coronary artery disease (PCAD) is increasingly recognized in younger adults and requires improved risk stratification. Conventional lipid markers may have limited discriminative value, particularly when lipid levels reflect ongoing statin therapy. This study evaluated the associations and discriminatory performance of metabolic, atherogenic, and anthropometric indices for PCAD and developed internally validated dynamic nomograms for PCAD case discrimination.Patient and Methods: This multicenter retrospective case-control study used data from the Iran Premature Coronary Artery Disease registry. A total of 3063 adults undergoing coronary angiography were included, comprising 1929 patients with PCAD and 1134 controls. Twelve metabolic, lipid-based, and anthropometric indices were calculated from fasting glucose, lipid profiles, and body measurements. Participants were randomly divided into training and validation cohorts at a 7:3 ratio. Logistic regression, receiver operating characteristic analysis, calibration assessment, integrated discrimination improvement, net reclassification improvement, and decision-curve analysis were used to evaluate model performance.Results: Atherogenic index of plasma (AIP), triglyceride-glucose index (TyG), and a body shape index (ABSI) showed consistent independent associations with PCAD. Individually, these indices showed modest discrimination. The conventional clinical model achieved an AUC of 0.677. Adding AIP and binary ABSI increased the AUC to 0.721, while the TyG plus binary ABSI model showed the highest performance, with an AUC of 0.724, representing modest but statistically significant improvements over the conventional model. Both final models showed favorable internal calibration, and improvement in reclassification metrics, and decision-curve net benefit. Two dynamic web-based nomograms were developed for individualized PCAD case discrimination.Conclusion: TyG, AIP, and ABSI were independently associated with PCAD and provided modest incremental discrimination beyond conventional risk factors in this predominantly statin-treated case-control cohort. The resulting dynamic nomograms provide an accessible framework for PCAD case discrimination; however, their clinical applicability and estimation of absolute risk require external validation in independent, preferably prospective, populations.Keywords: premature coronary artery disease, atherogenic index of plasma, triglyceride glucose index, a body shape index, dynamic nomograms
